National Sleep Foundation

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Chapter 1: Normal Sleep

Abnormal Sleep & Sleep Disorders

Sleep disorders are among the most common medical complaints in our society. The National Sleep Foundation’s (NSF) 2005 Sleep in America Poll indicated that 75 percent of adults surveyed reported having at least one symptom of a sleep problem at least a few nights a week — an increase from 62 percent in 1999, 69 percent in 2000, and 74 percent in 2002.6

Millions of Americans suffer from sleep problems, including:

· Insomnia, the most common sleep complaint, involves trouble getting to sleep and/or staying asleep, and/or experiencing unrefreshing sleep. About 30-40 percent of adults report some insomnia symptoms in any given year; about 10-15 percent of adults say they have chronic insomnia.7Insomnia as a distinct sleep disorder may be present with other sleep, medical or psychiatric problems. In fact, most insomniacs often have some sort of medical or psychtric problem that is co-morbid with insomnia, such as anxiety, depression, substance abuse, diabetes, Alzheimers’ disease, and/or chronic pain.

· Obstructive sleep apnea (OSA) is the most common form of sleep apnea. It occurs when the person’s airway collapses or is blocked (either totally or partially), which causes shallow breathing or a complete stoppage in breathing, thereby disrupting sleep. Estimates range, but it is thought that 4% of U.S. men, and 2% of U.S. women have OSA. Studies in other countries report similar prevalence rates.8 Most OSA is undiagnosed, however.9

· Excessive sleepiness disorder is persistent sleepiness (what is often referred to as “tiredness”), which interferes with a person’s productivity and quality of life. It can result from (1) insufficient sleep (e.g., insomnia), (2) poor quality sleep (e.g., sleep apnea), (3) erratic sleep patterns (e.g., shift work disorder), (4) medications and substances (e.g., prescription and over-the-counter medicationss, drugs, and “natural” remedies), and (5) brain damage (e.g., traumatic brain injury, narcolepsy).10According to NSF’s 2008 Sleep in America poll, in the last month, due to excessive sleepiness:

o 36 percent of Americans have driven while drowsy or fallen asleep while driving; 29 percent have fallen asleep or become very sleepy at work;

o 20 percent have lost interest in sex due to sleepiness; and

o 14 percent have missed family events, work functions, and/or leisure activities in the past month due to excessive sleepiness.11

· Circadian Rhythm Disorders all involve problems with an individual’s internal clock that disrupt his or her sleep patterns. Shift work disorder (SWD), is a form of Circadian Rhythm Disorder with serious medical and psychiatric consequences; it is predominantly experienced by those who work night shifts and early morning shifts.12 Shift workers are more likely to suffer from insomnia and excessive daytime sleepiness compared to those who work during the day (61% vs. 47%, and 30% vs. 18% respectively). Shift workers are also more likely to drive while fatigued and to fall asleep at the wheel.13

· Parasomnia: refers to all of the abnormal movements or activities that can happen while people sleep (other than sleep apnea), including sleep-related abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. They include eating disorders, sleepwalking, sleep talking, nightmares, sleep paralysis, REM sleep behavior disorder, and sleep aggression. Parasomnias affect about 10 percent of Americans and are more common in children due to their brain immaturity. 14

· Restless legs syndrome (RLS) is a neurological disorder that causes uncomfortable (and sometimes painful) tingling and tugging sensations in the legs. RLS symptoms usually come on in the evening and intensify as the night goes on. Movement of the limbs instantly relieves the discomfort, then being still once again makes them worse. RLS almost always interferes with one’s ability to fall asleep and to stay asleep. Most people with this disorder feel tired during the day, since RLS interferes with sleep’s restorative process. RLS is often undiagnosed or misdiagnosed; about 10 percent of American adults suffer from RLS, fewer among younger people, more among the elderly. 15

15. National Sleep Foundation (NSF). Restless Leg Syndrome, Arlington: NSF, no date. Available at: http://www.sleepfoundation.org/article/sleep-related-problems/what-restless-legs-syndrome-rlsSleep disorders are among the most common medical complaints in our society. The National Sleep Foundation’s (NSF) 2005 Sleep in America Poll indicated that 75 percent of adults surveyed reported having at least one symptom of a sleep problem at least a few nights a week — an increase from 62 percent in 1999, 69 percent in 2000, and 74 percent in 20021.